[Medical-surgical course of neonates with gastroschisis according to time, abdominal closure method and intestinal involvement: six years of experience].

INTRODUCTION

Gastroschisis is a common congenital abdominal malformation. The management of this disease is by surgical repair. The two most common modes of repair are staged silo repair and primary closure. The outcomes of both modalities of surgical repair vary extensively from each published study. Experience in Mexico is limited.

OBJECTIVE

Compare clinical and surgical evolutions between neonates with gastroschisis and evaluate associated risks and complications.

METHODS

In a cohort study of six years (2003-2008) we evaluated patients with diagnosis of gastroschisis treated by staged silo repair and primary closure. We compared time of ventilation, fasting, total parenteral nutrition, full feeds, length of hospital stay, medical and surgical complications, and mortality. Statistical analysis was performed using Student t-test, chi2 and Mann-Whitney U test. Relative risk factor (95% confidence interval) was calculated and logistic regression analysis was performed.

RESULTS

Thirty four neonates with gastroschisis were included, 24 (70.5%) were treated by primary closure, 10 (29.5%) by staged silo repair, 14 (41.2%) underwent primary closure before 24 hours of life, 20 (58.8%) after 24 hours, 5 (14.7%) showed mild intestinal compromise, 22 (64.7%) moderate and 7 (20.6%) severe intestinal compromise. A significant difference was observed (p < 0.001) for each study variable with an exception in hospital discharge (dead or live) regarding the degree of intestinal compromise. Severe intestinal compromise was associated with an increase in medical (RR 1.46; IC 95%: 1.10-1.95) and surgical complications (RR 1.83; IC 95%: 0.97-3.44).

CONCLUSIONS

There is no difference regarding hospital stay between neonates treated before or after 24 hours of life and also between patients treated by primary closure or staged silo repair. Nonetheless, newborns that presented severe intestinal compromise had a worse evolution and more medical and surgical complications.